DEVELOPING A GERIATRIC EMERGENCY DEPARTMENT BY FOCUSING ON THE THREE PS: PEOPLE, PROCESSES, AND PLACE

Abstract Older patients’ emergency department (ED) visits in the U.S. rose a surprising 30% during the period 2015-2019 to about 28 million visits annually. Many EDs are now examining emerging geriatric emergency department (GED) models of care to address the care needs of this population. This paper provides a practical overview of how to develop a GED and introduces the 3 Ps model focusing attention on the ED’s People, Processes, and the Place thereby providing a clear framework for practical GED development. Key resources facilitating GED development includes: the national GED Collaborative (GEDC) organization, the nationally endorsed GED Guidelines, and resources associated with the Geriatric Emergency Department Accreditation process. Core clinical elements needed to create a GED’s operations are found in its care processes including: 1) General approaches to the patient; 2) Screening for high-risk conditions; 3) Enhanced assessment for older patients; 4) potential workflow alterations; and 5) Attention to transitions into and out of the ED. The paper concludes by provides additional practical guidance to EDs seeking to enhance the ED experience of older people and improve the quality of their outcomes.

rank-based enrichment analysis identified several metabolites significantly associated with survival independent of age, including secondary and primary (C 24) bile acids, and multiple classes of steroids (androgens, pregnenolone, progestin), among others.Additional analyses are ongoing to further annotate and characterize these findings.If validated, these results could contribute to the identification of novel healthy aging therapeutics.

DISTANCE-BASED ANALYSIS OF LONGEVITY-RELATED METABOLOMIC PROFILES
Nicholas Schork 1 , Avijit Podder 2 , Nivedita Bhadra 2 , Janith Don 2 , and Anish Raju 2 , 1.The Translational Genomics Research Institute (TGen), Phoenix, Arizona, United States,2. TGen,Phoenix,Arizona,United States Longevity is a complex multifactorial trait with many interacting determinants.Identifying each determinant is complicated given that the marginal effect of any one of them may be small.Contemporary high-throughput biomedical assays, such as transcriptomics, proteomics, and metabolomics assays, generate large amounts of very appropriate data for identifying the determinants of longevity, but can be problematic from an analysis viewpoint.For example, the analytes interrogated by these assays are often correlated, include missing data, are often noisy, and typically reflect their contributions to broader underlying, yet often unknown, pathways, processes, and networks.Standard methods for analyzing such data, which focus on each individual analyte's association with a condition of interest (e.g., long life, health status, etc.) and then exploring commonalities among any associated analytes, can be complemented by multivariate analysis methods that consider the association between different groups of metabolites (e.g., defined by a pathway) and the condition of interest.Distance-based multivariate analysis methods can be used in such settings.We showcase the utility of novel distance-based techniques in the analysis of human and cross-species metabolite data and longevity-related phenotypes collected from the Longevity Consortium (LC).These methods consider the overall similarity of metabolomic profiles among individuals or species with and without, e.g., a long life or a particular age-related disease, or deviations from an optimal longevity associated profile, and have much greater power than aggregated univariate methods when certain assumptions are upheld.We find a number of multivariate patterns in the LC data that could motivate further research.
Older patients' emergency department (ED) visits in the U.S. rose a surprising 30% during the period 2015-2019 to about 28 million visits annually.Many EDs are now examining emerging geriatric emergency department (GED) models of care to address the care needs of this population.This paper provides a practical overview of how to develop a GED and introduces the 3 Ps model focusing attention on the ED's People, Processes, and the Place thereby providing a clear framework for practical GED development.Key resources facilitating GED development includes: the national GED Collaborative (GEDC) organization, the nationally endorsed GED Guidelines, and resources associated with the Geriatric Emergency Department Accreditation process.Core clinical elements needed to create a GED's operations are found in its care processes including: 1) General approaches to the patient; 2) Screening for high-risk conditions; 3) Enhanced assessment for older patients; 4) potential workflow alterations; and 5) Attention to transitions into and out of the ED.The paper concludes by provides additional practical guidance to EDs seeking to enhance the ED experience of older people and improve the quality of their outcomes.

EFFECTS OF MINDFULNESS ON COGNITION IN ADULTS WITH MILD COGNITIVE IMPAIRMENT: A META-ANALYSIS
Rose Lin 1 , Jingjing Su 2 , and Kathi Heffner 3 , 1. University of Rochester, Rochester, New York, United States, 2. Hong Kong Polytechnic University, Hong Kong, Hong Kong, 3.

University of Rochester Medical Center, Rochester, New York, United States
Mindfulness, or present-moment awareness, has been linked to greater psychological well-being and cognitive health in older adults.Recent studies on mindfulness-based intervention further explored its cognitive benefits in adults at the preclinical stage of dementia, yet showing mixed results.Therefore, this meta-analysis synthesizes the effects of mindfulness-based intervention on cognitive function for adults with mild cognitive impairment (MCI).Literature search was conducted in MEDLINE, EMBASE, PubMed, CINAHL, Web of Science, and Scopus.Randomized controlled trials that examined the effects of a mindfulnessbased intervention on cognitive function in adults with MCI were included.Study effects were calculated by standard mean difference (SMD) and its 95% confidence interval using random effects model.Meta-regression was conducted to test the effects of methodological quality and intervention characteristics (qualification of interveners, types of mindfulness approach and control treatment) on trial effectiveness.Twelve trials involving 530 participants (female=64.26%,mean age=71.21years) were included.Half of the reviewed studies were pilot trials with a mean attrition rate of 18.7%.Pooled evidence suggested that mindfulness-based intervention exerts a small-to-moderate effect on global cognition (SMD=0.40;95%CI[0.14,0.66]),visuospatial ability (SMD=0.25;95%CI[0.03,0.48])and long-term memory (SMD=0.21;95%CI[0.01,0.41]).No significant effect was detected for short-term memory, executive function, and attention.Meta-regression showed that none of the covariates moderate the treatment effect.This meta-analysis suggested that mindfulness-based intervention might improve cognitive function and its more specific domains in adults with MCI.More research with larger sample is warranted to confirm the effectiveness and examine the underlying mechanism to explain the improved outcomes.In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020.To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures -dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization.Two-hundred fortyfour community-dwelling adults aged 60 to 97 with mild to moderate dementia were selected in an urban safety-net primary care clinic.Propensity -demographics and comorbidity was matched.Main outcomes were (A) number of hospitalization and 90-day rehospitalization rate, hospitalizationrelated healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021.One-hundred twenty-two patients were cared by primary care providers who received the IPETC;122 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021 of patients cared by providers with IPETC.Number of hospitalization with IPETC was fewer than those without IPETC (0.72 vs. 1.38, p < .01).Number of 90-day rehospitalization with IPETC was fewer than those without IPETC (0.14 vs. 0.30, p < .01).An average cost-saving of $20,289 per patient was observed among those with IPETC than those without IPETC (p < .001).CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.2% to 24.7% in documented advance care plans.

THE HOSPITAL TO HOME TRANSITION: EFFECTS OF LIFE CHANCES AND LIFE CHOICES ON UNPLANNED HOSPITAL READMISSIONS
Dale Yeatts, and Cynthia Cready, University of North Texas, Denton, Texas, United States Roughly 18% of all patients discharged from hospitals in the United States experience an unplanned hospital readmission (UR) within 30 days which can be life-threatening to patients and extremely costly for the health care system.Medicare alone paid $900.8 billion in 2021, or 21 percent of total national hospital expenditures.A promising theory for adding to our understanding of the causes for URs is Health Lifestyle Theory (HLT).It proposes that structural factors (e.g., SES, hospital procedures) affect one's life chances and that socialization and personal experiences affect one's life choices and the two merge to produce a person's health